Pregnancy Intentions and Folic Acid Supplementation Exemplars: Findings from the Central Pennsylvania Women's Health Study

One Healthy People 2010 objective is that 80% of women in the United States start a pregnancy with optimal levels of folic acid. This often requires women to use folic acid supplements preconceptionally to get adequate levels. Efforts to achieve the objective have resulted in a suboptimal floor effect at less than 50% of women. We advance a framework based on exemplification theory, identifying supplementation as an additive action in which two role models exemplify folic acid supplementation among women of reproductive age able to become pregnant (n=1,258). The women were participants in Phase I of the Central Pennsylvania Women's Health Study (CePAWHS). One exemplar identified represents the positive habits aligned with supplementers considering a pregnancy sometime in their future, while the other resides in the exemplification of positive habits aligned with supplementers not considering a pregnancy sometime in their future but still able to become pregnant. Among women not considering a future pregnancy, daily green salad consumption, weekly fish consumption, having had a health care visit in the past year, and having had any ob/gyn visit in the past 2 years resulted in increased odds of folic acid supplement use in a multivariable model. In the same model, an increase in age resulted in increased odds of folic acid supplement use. Among women considering a future pregnancy, not smoking cigarettes, having higher levels of psychosocial stress, and having higher levels of interaction social support resulted in increased odds of folic acid supplement use in a multivariable model. In the same model, those who have had a health care visit in the past year, as well as those who have received pregnancy planning counseling, were also more likely to use a folic acid supplement. Implications for strategic communication are considered.